Black MSM, PrEP Access Top Focus of New CDC HIV Prevention Funding
More than $216 million over a five-year period has been awarded to 90 community-based organizations (CBOs) by the U.S. Centers for Disease Control and Prevention (CDC). The majority of the funding is for HIV prevention strategies for gay, bisexual and other men who have sex with men (MSM), as well as African-American communities. New funding will also go to increase access to pre-exposure prophylaxis (PrEP) for black MSM -- the demographic that has been most impacted by the epidemic.
"Young black men who have sex with men continue to be the most disproportionately impacted by HIV disparities. PrEP represents a potential paradigm shift for all communities but particularly for young black men who have sex with men," said DaShawn Usher, chairman of the Washington, D.C.-based Young Black Gay Men's Leadership Initiative (YBGLI). "Access remains one of the greatest barriers among this population. If more young black men who have sex with men [have] access to PrEP, we could see major changes in current HIV rates and other health disparities in our peers over time."
The announcement was made on Wednesday, July 1 -- a historic week in the history of the epidemic. It was almost 34 years to the date -- on July 3, 1981 -- when The New York Times published its first report of a mysterious and almost fatal "gay cancer" seen in New York and California.
Researchers discovered the human immunodeficiency virus in 1983, two years after the first cases of "gay-related immunodeficiency" were first reported. Treatment, care, testing and prevention technologies have dramatically improved health and longevity outcomes since then. A "positive" diagnosis is now a chronic but manageable condition. More than 1.2 million people in the U.S. are living with HIV infection today, according to CDC estimates. But almost one in eight are unaware of their infection.
The 90 CBOs being funded are in the "50 geographic areas that reported the highest number of HIV diagnoses" in 2011, according to the Atlanta-based CDC. The funding has been awarded to CBOs in 26 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.
"Community-based organizations have been vital to our nation's HIV prevention efforts since the earliest days of the epidemic," said Jonathan Mermin, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, in a statement. "The organizations we're funding have a strong foothold in the hardest-hit communities. They have the credibility and experience needed to deliver the most effective HIV prevention strategies to those who need them most."
Of the 90 directly-funded CBOs, 67 primarily serve African Americans and 15 primarily serve Latinos. Sixty-four of these organizations -- or 71.1% -- primarily serve MSM. Gay, bisexual and other MSM -- particularly young black MSM -- are most seriously impacted by HIV. New infections grew by an "alarming" 48% among young black MSM aged 13 to 29 between 2006 and 2009.
African-American and other black communities represent 14% of the nation's population but account for about 44% of all new HIV infections. Black and Latina women are also disproportionately impacted. African-American women account for more than 60% of all infections among women. African Americans and Latinos are more likely to be "late testers" and diagnosed with AIDS within one year of their HIV diagnosis. That means they are less likely to benefit from life-saving medications.
The funding will be directed toward HIV testing, care and treatment, condom distribution and sexually transmitted infection (STI) screening, as well as prevention and support services. The funding will also target key populations to ensure HIV-negative individuals "have access to prevention and support services such as pre-exposure prophylaxis [and] post-exposure prophylaxis."
PrEP is a biomedical prevention strategy that involves healthy, HIV-negative individuals taking the oral antiretroviral medication Truvada (tenofovir/FTC) daily. PrEP can be almost 100% effective against acquiring HIV for those who take the medication daily.
"PrEP has been demonstrated to be efficacious in preventing HIV. However, significant gaps exist regarding uptake and implementation among" black MSM, noted Usher. "It is imperative that we do more work to ensure that access to PrEP is seamless and affordable."
The largest increase in new infections is in the South. Many of these states are disproportionately lower income, have larger concentrations of African Americans and more people living without access to health care or health care insurance. CDC's new round of funding includes resources for CBOs across the South -- in Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee.
Atlanta, Georgia, has become one of the regional epicenters of the epidemic. "Grady Hospital -- Atlanta's public health hospital -- found that half of the people who were diagnosed with HIV in its emergency room already had a clinical AIDS diagnosis," said Kenyon Farrow, the U.S. and global health policy director of the Treatment Action Group. "A significant number of those will be black gay and bisexual men, as well as black transgender women."
Atlanta boasts the nation's fifth highest ranking among metropolitan statistical areas of residence for new diagnoses of HIV. The funding announcement included $15 million over a five-year period to nine different Atlanta-area CBOs to go toward HIV prevention efforts, reported the GA Voice.
Rod McCullom has written and produced for ABC News and NBC, Scientific American_,_ The Atlantic_,_ The Nation_,_ Ebony_,_ Poz and many others. He will become a Knight Science Journalism Fellow at the Massachusetts Institute of Technology later this summer.